The Luna Care Team provides supportive and comprehensive prenatal care to low risk women. Midwifery care allows families to have the time and space they need to make informed decisions about their pregnancy, birth, and postpartum care. Prenatal appointments involve generous information and support, as well as a physical assessment of mother and baby, including: routine blood tests, limited ultrasound, and referrals to our community partners if needed. In such a transitional, powerful, and intimate time as pregnancy, we believe there is no substitute for a strong relationship between a woman and her birth team.
Adequate prenatal care is required for each woman preparing for an out-of-hospital birth. This is a safeguard for her health, as it allows the midwife to watch for any risk factors that might make out-of-hospital birth unwise. It also offers the pregnant woman the opportunity to learn about the changes her body goes through as pregnancy advances and allows the midwife and client to develop a bond of communication and trust that is immeasurably helpful to both of them.
General frequency of visits:
- Begin care as early in pregnancy as you like
- Monthly visits until approximately 28 weeks
- Every two weeks until approximately 36 weeks
- Weekly until 41 weeks
- Every few days through 42 weeks
- More frequent visits are available at any time, for any reason
Are you a good candidate for out-of-hospital birth?
Only women experiencing normal pregnancies should consider out-of-hospital birth. Fortunately, pregnancy is not usually pathological and most pregnancies proceed without complication.
To be certain you are a good candidate, we will evaluate your risk factors, both physically and psychologically. There are certain health factors that may make out-of-hospital delivery unwise. We screen for these possibilities by first asking questions about your health, reviewing your health history and blood work results, and then watching carefully for any problems throughout the prenatal period. Below are guidelines for our practice; these may be adapted to particular situations according to our judgment and experience.
Risk Out, including, but not limited to:
- Pre-existing chronic medical conditions requiring ongoing medical management (essential hypertension, CVHD, DM Type 1 or 2, uncontrolled asthma, renal or hepatic disease, organ transplant, hemoglobinopathy, unless trait)
- Previous or current psychosis requiring drug therapy
- RH sensitization
- Active/current seizure disorder
- Multiple gestation (upon dx or by 20wk gestation)
- Pre-pregnant BMI > 45
- Clotting disorders on anticoagulant therapy
- History of thromboembolic disease or pulmonary embolus
- History of cancer with chemotherapy and/or radiation
- GDM on insulin
- Retained placenta >2x with PPH
- Complete previa after 26 weeks
- Sickle cell disease
- Congenital Heart Disease with current symptoms, complex history, and/or multiple surgeries
- Congenital heart defect
- Mechanical heart valve
- Use of anticoagulants
Consider consultation upon accepting including but not limited to:
- Auto-immune disorders
- Controlled chronic medical conditions
- BMI 40 – 44 with comorbidities
- Substance abuse, active, excluding THC
- Thromboembolic disease or clotting disorder
- Documented IUGR or history of IUGR with recurrent causes
- Other obstetric conditions requiring consultation in accordance to CNMs scope of practice
There may be other antepartum situations requiring consulting, co-management, or transferring out of Luna WWBC care these we will be reviewed on a case by case basis.
Women/families who choose out-of-hospital birth are accepting a high level of responsibility for themselves and their baby. Clients need to be self-motivated to take on that responsibility, and to make necessary changes in their lives to ensure the best possible outcome. These changes may involve nutrition, exercise, stress reduction, devoting time for prenatal care and education, and avoiding substances that could be harmful to the developing baby.
Out-of-hospital birth clients must agree to:
- adhere to the guidelines provided for the course of their care
- keep their appointments
- read, research, prepare for their birth, including attending required childbirth classes
- actively participate in all aspects of their care, and communicate any concerns that they may have
- have the mother of the baby abstain from recreational drug use, alcohol, and cigarettes, & avoid exposure to second-hand smoke
- eat plenty of fresh, wholesome foods and limit “junk” foods
- exercise in ways appropriate for pregnancy
- assume financial responsibility for services rendered
- The physical and emotional environment of the client’s chosen place of birth should be conducive to having an out-of-hospital birth as well. The client and her partner must both be comfortable with out-of-hospital birth.